New Provider Directory Initiative To Advance Solutions For Data Accuracy, Coordination With Providers

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For Immediate Release

Washington, D.C. — As consumers increasingly rely on provider directories to make decisions about their health coverage and where they receive care, America’s Health Insurance Plans (AHIP) is launching a new initiative to identify solutions for improving the accuracy and efficiency of data reporting with provider partners. This new pilot project builds on the industry’s ongoing efforts to improve consumers’ access to care and to provide the information they need to make informed health care choices.

Health plans’ provider directories are key tools for individuals and families. These directories include a compilation of providers, clinicians, and health care facilities that participate in health plans’ networks. Consumers who choose in-network providers are protected from unexpected medical bills including balance billing.

However, one of the persistent challenges with data reporting and maintenance of provider directories is confirming and updating provider information in real time. To identify actionable solutions for this issue, AHIP and 12 member plans from across the commercial, Medicaid, and Medicare markets will test various approaches for coordinating with providers to update and verify directory data.

“Consumers benefit when they have the information they need to make the best decisions about their coverage and their care,” AHIP President and CEO Marilyn Tavenner said. “Updating and maintaining provider directories is a shared responsibility between health plans and providers. This latest pilot effort is designed to proactively address gaps in reporting in order to improve the experience for consumers and simplify the process for providers.”

AHIP will work with BetterDoctor and Availity, two leading health care information and technology firms that focus on provider directory outreach and data updates, to launch the pilot projects starting April 2016 in three states — California, Indiana, and Florida. Currently, 12 AHIP member plans are participating in the effort, including:

Anthem (California & Indiana)

AvMed (Florida)

Blue Shield of California (California)

Cigna (Florida)

Florida Blue (Florida)

Health Net (California)

Humana (California, Indiana & Florida)

L.A. Care Health Plan (California)

Molina Healthcare of California (California)

SCAN Health Plan (California)

WellCare (Florida)

Western Health Advantage (California)

Rather than receiving requests or inquiries from multiple health plans, the pilot is designed to facilitate one primary point of contact for providers when updating or reporting changes to their practice information. Providers may be contacted by phone, email, or fax with instructions on how to update their information. BetterDoctor and Availity will then share data changes with the participating health plans to update their online and hard-copy directories.

The six-month initiative will allow health plans to identify best practices in communication outreach and potential solutions for updating their provider directories through a centralized database.

For more information on this effort, view our FAQ here. For more information on health plans’ networks and provider directories, click here.